真菌病

20100416马拉色菌致病相关因子研究进展(综述)/占萍(江西省皮肤病专科医院),李智升,耿承芳∥国际皮肤性病学杂志.-2009,35(5).-333～335马拉色菌是一类嗜脂性酵母,为人体和温血动物皮肤正常寄居菌,在一定条件作用下,可导致多种皮肤疾病。研究显示,马拉色菌致病涉及的机制复杂,与其本身毒力因子、基因型以及机体免疫力和皮肤微环境等多个因素密切相关。从基因组学和蛋白质组学水平上的研究,将进一步揭示马拉色菌与机体的相互作用,从而更好地解释该菌致病的病理学和免疫学机制。参24(樊靖华)20100417以S2-R2为引物PCR检测石蜡切片中的孢子丝菌/王东(大连医大附一院),刘晓明,张振     

马拉色菌外分泌物的研究进展

马拉色菌为人体皮肤常住菌,亦是条件致病菌.马拉色菌与花斑糠疹、马拉色菌毛囊炎、特应性皮炎、头皮屑、脂溢性皮炎及银屑病等多种皮肤病相关.马拉色菌在生长繁殖过程中会产生多种外分泌物,包括蛋白质及代谢产物等.近年研究多集中在马拉色菌外分泌蛋白中,其中脂肪酶、蛋白酶、磷脂酶、脂氧合酶、过氧化氢酶和酸性磷酸酶等酶类物质的种类、数量、活性可能与马拉色菌的致病相关.马拉色菌外分泌性代谢产物研究较少,malassezin、吲哚[3,2?b]咔唑、β咔啉生物碱等代谢产物与生物体的功能变化有直接的联系.马拉色菌外分泌物的研究,对阐明马拉色菌的致病机制具有指导意义,可能为治疗提供新思路.     

脂溢性皮炎致病因素中马拉色菌致病作用的系统评价

目的:明确脂溢性皮炎的致病因素以及马拉色菌在致病中是否起重要作用.方法:应用计算机和人工检索国内外与脂溢性皮炎研究有关的文献,按照循证医学非随机研究的系统评价方法,分析脂溢性皮炎病因学研究的证据,并进行综合评价.结果:自1950年以来有关病因学研究的49篇外文文献均认为其发病是多因素综合作用,基本集中在马拉色菌属酵母、脂质作用和个体易感性3个方面,其中以对马拉色菌致病性研究最多.5篇中文病因学研究文献中4篇不符合质量要求.结论:脂溢性皮炎的发病主要是在个体易感性基础上,机体对共生的马拉色菌菌体,及其脂酶分解皮脂产生游离脂肪酸的反应性增强,破坏皮肤屏障功能并引起皮肤炎症反应.抗真菌治疗可通过减少马拉色菌菌量而缓解皮肤炎症,提示马拉色菌在脂溢性皮炎的发病机制中起重要作用.     

花斑糠疹与马拉色菌毛囊炎相关危险因素和致病菌分析

目的 研究花斑糠疹和马拉色菌毛囊炎的相关危险因素和致病菌特点,并比较其差异。方法 收集我院临床花斑糠疹和马拉色菌毛囊炎患者,均以1：1设置病例对照组,调查发病相关因素,采用SPSS16.0软件进行单因素和多因素Logstic回归分析。培养阳性菌株采用形态学和生理生化学方法鉴定到菌种,比较菌种分布。结果 共收集到163例花斑糠疹和132马拉色菌毛囊炎患者。单因素回归分析显示与花斑糠疹发病相关的因素有多汗和油性皮肤,与马拉色菌毛囊炎发病相关的因素有男性、潮湿环境、多汗、油性皮肤、刺激性食物、甜腻食物。多因素回归分析显示花斑糠疹的危险因素有多汗和油性皮肤,马拉色菌毛囊炎的危险因素有多汗、油性皮肤、男性和甜腻性食物。两种疾病致病菌均以合轴马拉色菌为优势菌,但糠秕马拉色菌在毛囊炎中占较高比例。结论 多汗和油性皮肤是花斑糠疹和马拉色菌毛囊炎共同的危险因素,而男性、甜腻性食物为马拉色菌毛囊炎独有的危险因素,两种疾病致病分布也存在统计学差异。     

马拉色菌属的研究进展

马拉色菌是一种寄生于人和动物正常皮肤表面的真菌,可导致机会感染而引起各种马拉色菌属相关疾病。马拉色菌的致病机制主要是分解脂质,导致角质形成细胞形态学改变和细胞凋亡。马拉色菌可引起花斑癣、脂溢性皮炎、马拉色菌毛囊炎等,在特应性皮炎中也起到变应原的作用。对于这些疾病的治疗可使用抗真菌药物。     

无锡和南京地区汗斑病原菌种的分布

探讨汗斑患者马拉色菌的菌学特征和分布取临床标本做镜检和培养，观察菌的形态学特征，并采用一系列牛化鉴定方法鉴定菌种。各菌种菌落形态不同，特别是钝形马拉色菌和球形马拉色菌菌落形态特征明显，孢子形态具有特征性，容易鉴别，可作为鉴定指标之一；致病优势菌依次为糠秕马拉色菌、合轴马拉色菌，球形马拉色菌等。准确鉴定屿拉色菌需结合形态学和生化特征；7个致病菌种在汗斑皮损均有分布。     

婴儿皮肤马拉色菌带菌及菌种调查

目的了解1~6个月婴儿皮肤马拉色菌带菌情况和菌种构成及其影响因素。方法采用胶带法粘取1~6个月婴儿额部皮肤处鳞屑,接种于含菜子油培养基进行真菌培养分离马拉色菌,并用生理生化及形态学方法鉴定菌种。结果①75例婴儿皮肤标本有54例培养出马拉色菌,培养阳性率为72%;②共分离出56株马拉色菌,以糠秕马拉色菌、球形马拉色菌、合轴马拉色菌为主;③按月龄、性别、生产方式等因素的不同进行分组,结果不同月龄、性别婴儿皮肤马拉色菌阳性率及菌种构成比较差异均无统计学意义;不同生产方式婴儿马拉色菌培养阳性率比较差异无统计学意义但菌种构成比较差异有统计学意义。结论马拉色菌是婴儿皮肤的常驻菌;婴儿皮肤马拉色菌以糠秕马拉色菌、球形马拉色菌、合轴马拉色菌为主。婴儿皮肤马拉色菌阳性率不受月龄、性别、生产方式等因素的影响,婴儿皮肤马拉色菌菌种构成不受月龄、性别影响。     

马拉色菌及其相关皮肤病诊治进展

1 马拉色菌分类命名进展 对马拉色菌(Malassezia)酵母认识及其与人类和动物疾病的关系探索迄今已有150余年.经历了马拉色菌-糠秕孢子菌(Pityrosporum)-马拉色菌的命名过程,在对各菌种形态学和生理生化学特性研究基础上,随着脉冲凝胶电泳和随机扩增多态性分析、DNA序列分析等分子生物学技术的应用,现分为14个种,分别为:糠秕马拉色菌、合轴马拉色菌、斯洛菲马拉色菌、钝形马拉色菌、球形马拉色菌、限制性马拉色菌、厚皮马拉色菌、皮肤马拉色菌、纳娜马拉色菌、日本马拉色菌、大和马拉色菌、羊马拉色菌、马马拉色菌和兔马拉色菌.     

南通和南京马拉色菌毛囊炎临床调查及致病菌种分析

目的 探讨南通和南京马拉色菌毛囊炎的易感因素及致病菌种在不同地区、不同部位马拉色菌毛囊炎中的菌种分布情况。方法 对符合病例收集纳入标准的患者进行问卷调查,取毛囊内容物进行真菌涂片、培养;并根据形态学和生理生化特征进行菌种鉴定。结果 241例临床诊断为马拉色菌毛囊炎的患者,真菌涂片204例阳性,涂片阳性率84.65%;收集标本259份,共得阳性株213株,其中马拉色菌209株,念珠菌4株（占1.54%）,真菌培养阳性率82.24%。菌种鉴定：209株马拉色菌活化菌种后,可供鉴定的马拉色菌菌株186株,共检测到6个菌种的马拉色菌,其中糠秕马拉色菌111株（59.68%）、斯洛菲马拉色菌43株（23.12%）、合轴马拉色菌17株（9.14%）、球形马拉色菌9株（4.84%）、厚皮马拉色菌4株（2.15%）、钝形马拉色菌2株（1.08%）。不同个体、不同部位的菌种分布：胸部、后背、腹部和面颈部以糠秕马拉色菌为主,上肢、肩部和头顶以斯洛菲马拉色菌为主,下肢均为球形马拉色菌。同一个体、不同发病部位存在不同的菌种,主要为糠秕马拉色菌合并合轴或斯洛菲马拉色菌。 结论 南通和南京马拉色菌毛囊炎存在6种马拉色菌致病菌种,糠秕和斯洛菲马拉色菌是主要的致病菌种。     

马拉色菌分子生物学研究方法与应用

马拉色菌作为一种嗜脂性的条件致病真菌,目前至少可分为14个菌种,然而传统的表型鉴定方法对生理生化特征不典型的马拉色菌菌株难以鉴定,近年来对马拉色菌分子生物学方面的研究为马拉色菌属的分类及流行病学研究提供了更为准确的方法。本文就马拉色菌的相关分子生物学鉴定进展做一综述。     

Subungual glomus tumor diagnosis based on imaging

A 50-year-old woman had had tenderness of the nail bed of the right thumb for more than 20 years. For the previous 5 or 6 years, she had also had attacks of pain with exposure to cold, and deformity of the right thumb nail plate began to appear. There was red discoloration on the proximal aspect of the nail bed, and a longitudinal fissure on the distal aspect of the nail plate. Ultrasonography showed a well-circumscribed hypoechoic area under the proximal aspect of the nail plate and the nail matrix. Color Doppler ultrasonography showed subtle flow signals within the hypoechoic area. Magnetic resonance imaging showed a well-circumscribed mass in the same place that the ultrasonography indicated. It was isointense to the dermis of the nail bed on the T1-weighted image and hyperintense on the T2-weighted image. Radiography showed subtle dorsal bone erosion in the distal phalanx. Surgery was performed. Histologically, the diagnosis of a subungual glomus tumor was made. We diagnosed the exact location and size of the subungual glomus tumor by preoperative imaging and completely removed it easily and safely. Imaging is very useful for diagnosing tumors of the nail unit.     

Morphology of Sarcoptes Scabiei (variety hominis) under scanning electron microscopy]

Some morphologic aspects of S. S. by SEM in twelve parasites (female) extracted from the lesions with a pin are studied. We think that the extraction method and the posterior colocation of the parasite has contributed to its better understanding. We describe the dorsal cleft, a characteristic formation of the sarcoptidos, tapered on both sides with thorns in the form of shark's teeth. We analyze the details of the Ambulacro, constituted by the cut or the strait Pedicelo, with a distal extremity in the form of Condyl in which the suction cups are articulated. We can see, in the anogenital portion, two independent anal and genital orificius and, in the ventral area, the tocostoma, or cleft, where the eggs are deposited. Finally we analyze the bucal organs, the Pedipulpos, the morphology and disposition of the hipostoma and the queliceros.     

Electron microscopic study of the human adult intraepidermal eccrine sweat duct--the formation of the intracytoplasmic cavity

The human adult intraepidermal eccrine sweat duct (IESD) were studied by the transmission electron microscope. The formation of the intracytoplasmic cavities was demonstrated in the luminal cell of the adult IESD, and the relation between the intracytoplasmic cavities and the IESD formation was as follows. On the eccrine sweat duct ridge, these intracytoplasmic cavities enlarged, broke through the cell membrane and coalesced into the intercellular lumen. Furthermore, several intercellular lumina were merged into the intraepidermal ductal lumen. In the lower to upper squamous layers, small intracytoplasmic cavities were formed around the intraepidermal duct and were fused into the duct. Simultaneously, the contents of the intracytoplasmic cavities were discharged into the ductal lumen. Intracytoplasmic cavities in these layers were ordinarily formed and concerned in not only the reconstruction of the duct but also the secretory function. The intracytoplasmic cavities were surrounded with the same microvilli as lined the intraepidermal ductal lumen. Many clear vesicles (about 0.1 microns in diameter) were observed near the intracytoplasmic cavities, but multivesicular dense bodies (MDB) were not seen near the cavities. These vesicles were considered to participate in the formation of the intracytoplasmic cavities.     

Finger and toenail onycholysis

Onycholysis – the separation of the nail plate from the nail bed occurs in fingers and toenails. It is diagnosed by the whitish appearance of the separated nail plate from the nail bed. In fingers, the majority is caused by trauma, manicuring, occupational or self‐induced behavior. The most common disease producing fingernail onycholysis is psoriasis and pustular psoriasis. Phototoxic dermatitis, due to drugs can also produce finger onycholysis. Once the separation occurs, the environmental flora sets up temporary colonization in the available space. Finger onycholysis is most common in women. Candida albicans is often recovered from the onycholytic space. Many reports, want to associate the yeast as cause and effect, but the data are lacking and the treatment of the candida does not improve finger onycholysis. A reasonable explanation for the frequent isolation of Candida and Pseudomonas in fingernail onycholysis in women, is the close proximity the fingers have to the vaginal and gastrointestinal tract. Fifty per cent of humans harbour C. albicans in the GI tract and it is frequently carried to the vagina during hygienic practices. Finger onycholysis is best treated by drying the nail ‘lytic’ area with a hair blower, since all colonizing biota are moisture loving and perish in a dry environment. Toenail onycholysis has a very different etiology. It is mechanical, the result of pressure on the toes from the closed shoes, while walking, because of the ubiquitous uneven flat feet producing an asymmetric gait with more pressure on the foot with the flatter sole.     

BIBLIOGRAPHY OF COMPARATIVE AND VETERINARY DERMATOLOGY. PART 12

The first installment of this continuing feature appeared in the Jan.-Feb. 1977 issue (p. 37), the second in March (p. 143), the third in April (p. 218), the fourth in May (p. 287), the fifth in june (p. 401), the sixth in july-August (p. 505), the seventh in September (p. 601), the eighth in October (p. 683), the ninth in November (p. 764), the tenth in December (p. 844), and the eleventh in january-February (P. 58).     

汶川地震后华西医院调整急救空间的实践分析

汶川地震后3周内,2621例伤员陆续直接从现场送到华西医院。在院领导的支持下配合形势的变化对急诊空间进行调整。优化急诊空间,在急诊空间规划时预留空间。震后12h内,伤员主要来源于成都市区及周边区域,以皮肤软组织伤和肢体骨折居多。在急诊科的就诊大厅由护士迅速分诊,再由医生在抢救室,清创间以及普通诊断室按常规流程进行诊治。接着,大量重伤员从重灾区运来。医院增设等待分流区。伤员初诊后,接受影像学和实验室检查后送至等待区接受另一批医生的诊治,从而使大量伤员得到及时分流。生命体征不平稳者在抢救室立即实施抢救。12h后,灾区伤者收治量剧增,伤情更为复杂。急诊科迅速将分检区扩大至医院停车场,由医师检伤后再将病员分流至诊疗区处理。3d后伤口感染的伤员增加。急诊科将伤者分为开放性和闭合性损伤两类,前者分流至半污染区,伤口分泌物快速涂片排除感染后再进入普通等待区,有感染性伤口的伤者进入感染区诊治。在平常的停车场一侧不与非感染诊疗区相通的区域搭棚设立感染区,伤者在此隔离,工作人员进出也要进行严格消毒,从而避免交叉感染和院内感染。与交通警察合作,对急诊科前的停车场实施交通管制,开辟单向循环快速抢救通道。清理乱停乱放车辆,人流车流完全分开。     

In psoriasis the epidermis, including the subepidermal vascular plexus, grows downwards into the dermis

In psoriatic lesions. capillaries in the papillary bodies seem elongated and increased in number. Most researchers postulate that there is angiogenesis of intrapapillary capillaries in psoriatic plaques. In this study we will show, by means of computer-aided three-dimensional reconstructions in four patients suffering from chronic plaque-type psoriasis, and in a healthy volunteer. that the elongation and increase of intrapapillary capillaries are not the result of angiogenesis. Our threedimensional reconstructions show that the papillary body of psoriasis contains lymph capillaries besides the blood capillaries. Additionally. an inclusion of two tips of papillary bodies into one papilla at the base of the rete ridges becomes obvious. The vessel of the two tips are connected by a hrizontal vessel. At the level of the horizontal connecting vessel there is the blind begining of a lymphatic vessel. The connecting blood vessel. as well as the lymph capillary. belong to the horizontal subpapillary venous plexus but lie within the papillary body. The three-dimensional reconstructions show that by growing towards the dermis, the rete ridges include the vessels of the horizontal plexus. Surrounded by rete ridges, these vessels appear as intrapapillary capillaries.     

淋球菌耐药性质粒的转移性研究

目的研究淋病奈瑟菌(简称淋球菌)所携带的质粒与耐药性之间的关系。方法对淋球菌耐药株所携带的质粒进行质粒消除实验,并以此消除的质粒转化感受态的大肠杆菌,比较耐药质粒消除和转化前后菌株的耐药性变化情况。结果在亚致死浓度的十二烷基磺酸钠(SDS)作用下,淋球菌的耐药质粒可以被部分消除(仍然携带42.5kb的质粒)或者完全消除,且消除子在消除前后对抗生素的耐药性发生不同程度的改变;而耐药质粒在不同种属的菌株之间可进行传递,淋球菌的耐药质粒可以传递给感受态的大肠杆菌,筛选出的转化子分别携带含有tetM基因的42.5kb四环素耐药质粒和携带含有TEM-1基因的7.4kb青霉素耐药质粒,转化子可产生对相应抗生素的耐药性。结论淋球菌耐药质粒在介导菌株对抗生素的耐药性起着重要作用,并且可以不同菌株间进行传递。     

The facial red fluorescence of ultraviolet photography: is this color due to Propionibacterium acnes or the unknown content of secreted sebum?

Background/purpose: Red fluorescence of the face induced by ultraviolet light is thought to be due to Propionibacterium acnes . However, recently there are reports correlating this red fluorescence with the amount of facial sebum secretion. This study was performed to investigate the relationship between the areas of facial red fluorescence with culture results of P. acnes and the amount of sebum secretion.
Methods: Nineteen patients with acne were included. P. acnes cultures were done on specimens obtained from areas with red fluorescence. In addition, the amount of facial sebum secretion and the skin surface pH (SSPH) were measured. Correlation analysis of these parameters and the culture results were performed with the image analysis data from the red fluorescence of the face.
Results: P. acnes was cultured in 36.5% of cases. The correlation of the culture rate with the red fluorescence areas was not significant. After classifying the patients into high-sebum and low-sebum groups, there was a significant difference in the red fluorescence areas. In addition, the red fluorescence area correlated with the SSPH.
Conclusions: The red fluorescence area showed a stronger correlation with sebum secretion than with the presence of P. acnes . This finding suggests that the red fluorescence is affected by sebum not just P. acnes .